Off With Their Heads! How China's Controversial Human Head-transplant Procedure Exceeds the Parameters of International Ethical Standards in Human Experimentation

• Publication year: 2019
• Citation: Vol. 47 No. 2

OFF WITH THEIR HEADS! HOW CHINA'S CONTROVERSIAL HUMAN HEAD-TRANSPLANT PROCEDURE EXCEEDS THE PARAMETERS OF INTERNATIONAL ETHICAL STANDARDS IN HUMAN EXPERIMENTATION

Deena Agamy^*

[Page 491]

TABLE OF CONTENTS

I. INTRODUCTION...................................................................................493

A. The Name "Head-Transplant".........................................493
B. Outline ............................................................................496

II. BACKGROUND....................................................................................497

A. The Surgery.......................................................................498

1. Protocol...............................................................499
2. Participants..........................................................501

B. Backlash from the Medical/Scientific Community............502

III. INTRODUCTION TO ETHICAL RESTRAINTS ON HUMAN EXPERIMENTATION.......................................................................504

IV. CHINA'S LAWS...................................................................................505

A. Ethical Review Process in China......................................506

V. ANALYSIS...........................................................................................510

A. Adherence to Bioethics ..................................................... 511
B. Informed Consent..............................................................513

1. Donor...................................................................517
2. Death?..................................................................518
3. Recipient..............................................................520

C. Risks & Benefits................................................................522
D. Scientific Design ............................................................... 526

[Page 492]

E. Research Participants.......................................................530

VI. INTERNATIONAL REPERCUSSIONS......................................................532

A. Medical Tourism...............................................................533

VII. POSSIBLE REMEDIES...........................................................................534

VIII. CONCLUSION......................................................................................537

[Page 493]

I. Introduction

Frankenstein is possibly the world's most popular mad-scientist story. In Mary Shelley's novel, a doctor reanimates a lifeless body stitched together with beautifully "selected features."¹ When his monster awakens, Dr. Frankenstein finds himself "unable to endure the aspect of the being [he] created" as "breathless horror and disgust filled [his] heart."² As Dr. Frankenstein pieced together body parts to create his monster, a question of personhood arose. Who is Frankenstein's monster? Has Dr. Frankenstein reanimated the person whose head is sewn to the body? Is an entirely new person created— one without a previous identity—that is the sum of all the people that make up his body? Or is the monster's identity created by society's perception of him, and not by the monster at all? Throughout the novel, the monster is not given a name even though he displays numerous human characteristics, such as trying to befriend village people.³ But, upon his rejection by society, he becomes violent.⁴

While Frankenstein is a work of fiction, it has inspired a "mad scientist" duo, Sergio Canavero and Xiaoping Ren, to complete the first human head-transplant surgery.⁵ This Note explores head transplants, a theoretically possible medical intervention that would involve two participants: a brain-dead donor with a healthy body, and a mentally sound patient with a failing body. The patient with the functioning brain, but failing body, will receive the healthy body of the brain-dead donor. The patient's failing body will die.

A. The Name "Head-Transplant"

Generally, when a person receives a transplant, the name of the transplant procedure refers to the organ or body part the conscious individual is receiving. For example, a person undergoing a hand transplant is receiving a hand. However, in this "head transplant", we see the opposite. The phrase "head transplant" implies that a body is receiving a head. In reality, the head is

[Page 494]

receiving a body. The recipient's body will inevitably die, but his head will receive a working body and, theoretically, continue living. The donor loses his body and so, his life. Consider this hypothetical: John Smith is a brain-dead patient who is kept alive on life support. His family has donated his body to science. Jacob Jones is a quadriplegic with a fully functioning brain. In fact, he has a high IQ and has made much scientific advancement in physics. Jacob receives the body of John and John will die. In this scenario, it is clear that Jacob is receiving a body transplant, instead of John receiving a head transplant.

The distinction between a head transplant and a body transplant is significant because the name of a medical procedure is significant. The name should clearly identify the thing. It is intended to explain what the doctors are doing, its purpose, and inherently justify the procedure. As this involves a transplant, not a routine medical procedure, it becomes "medically necessary" and a "treatment." By assigning medical nomenclature, society justifies "treating" it—whatever "it" may be—with science because someone identified a problem that was not known or recognized previously.⁶ We have seen this effect in the psychological community, particularly with "disorders" like homosexuality⁷ or female hysteria, which are no longer recognized disorders. This process of assigning medical nomenclature to behavior or biological features is called Medicalization. Medicalization, specifically, is a "process by which some aspects of human life come to be considered as medical problems, whereas before they were not considered pathological."⁸ For example, Kaja

[Page 495]

Finkler provides an example of medicalization in her article Experiencing the New Genetics: Family and Kinship on the Medical Frontier:

A peasant woman gave birth to two Down's syndrome children in succession. She was counseled to avoid having any more children; however, she refused to regard these children as suffering from an affliction. In fact, she claimed that she preferred such children because they were more docile and more manageable than her other children. The Down's syndrome children were also better field hands than the rest. For this peasant woman, her Down's syndrome children were an asset and unproblematic. By medicalizing their beings, the woman began to perceive her children negatively rather than as positive contributions to the household welfare.⁹

With this "head transplant," there's an implication that the body is the important aspect of a person; a head can be moved, but the body is valuable—everyone needs a functional body. By calling it a head transplant, the head is being equated to a hand, leg, heart, liver, or any other aspect of the body that can be freely removed and replaced to create a better-functioning person. This minimizes the fact that the brain holds very personal and individualized memories, feelings, thoughts, intellect, and that it works in unison with the body to create the personality of an individual. In contrast, a person that receives a hand transplant does not suddenly become a different person or have a hand that thinks and acts on its own.¹⁰

The danger of misnaming this procedure is that it implies those with a dysfunctional body are flawed. In the hypothetical scenario described above, Jacob, the quadriplegic, receives a body despite the fact that he is potentially able to live a safe life in a wheelchair, communicate openly with friends, and have an, arguably, valuable and fulfilling life. His life is not at risk. He will not die from his condition. He is simply displeased with his body and its limitations. This establishes the implication that disabled individuals are suddenly "less" than those that are able-bodied.—those with a deformity in one leg, no problem, just replace the leg.¹¹ Instead of accommodating or

[Page 496]

appreciating those with disabilities (such as the mother in Kaja Finkler's example above, who preferred her children with Down syndrome) the solution is to treat the head like a hand and move it. The only reason cited for referring to this procedure as a head transplant is because that is the name it was given.¹² Even though it is inaccurate, "it stuck."¹³

The surgery should, rightly, be called a "body transplant" and it will be referred to as such throughout this Note. Furthermore, the person donating the body will be referred to as the "donor" and the person receiving the body as the "recipient."

B. Outline

By allowing the body transplant procedure, China violates the ethical guidelines provided by the World Health Organization (WHO) and the Council for International Organizations of Medical Sciences (CIOMS), both of which recommend an ethical review board evaluate the ethical compliance of research and filter out research that is not scientifically valid.¹⁴ This Note will discuss the many ways China is violating international standards, including their own, by allowing this surgery to occur.

[Page 497]

Part II will discuss the process of the surgery, how the researchers intend to complete this transplant, and the response from the scientific community to the news of the impending procedure. It will also include an introduction to the participants in this surgery. Part III will address the international standards. Part IV will discuss China's laws and outline their ethical review process.

Part V will include an analysis of the international standards and how the proposed body transplant procedure either does or does not abide by those standards. The applicable Chinese laws will also be compared to...